Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | T004819 | NY |
NPI | 1003967779 |
---|---|
Provider Name | Mr. Bruce V Taggart |
First Address | Delmar, NY 12054-4027 |
Second Address | Cobleskill, NY 12043-5742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |